Influence of wartime stress and psychosocial factors in Lebanon on analgesic requirements for postoperative pain

Requirements of analgesics following appendectomy was used as a model to assess the impact of the civil war situation in Lebanon on patient reaction to pain. The records of 246 patients who had undergone appendectomy for acute appendicitis under general anesthesia with no complications or concurrent diagnoses were reviewed. Sixty seven of these patients were operated in the prewar years, 67 during the war and 112 in the postwar period. The total dose of analgesics in pethidine equivalents and the number of injections were calculated for each patient. In addition, socioeconomic, demographic and clinical data were collected on all these patients. Patients, operated during and after the war required significantly less postoperative analgesics compared to prewar patients. Following stepwise multiple regression analyses, it was shown that males, ward patients and residents of Beirut required significantly lower amounts of postoperative analgesics compared to females, private patients and those living outside Beirut. The major difference between the requirements of prewar patients and war time and postwar patients may be explained on the basis of a combination of patient and system related factors. System related factors may include a change in attitude and assessment of patient pain by nurses in war time that has continued after the war. Patient related factors may be secondary to changes in the perception of pain due to the stressful war situation.